Short-term autonomy and survival after hepatectomy in the elderly

Aim: To study morbi-mortality, survival after hepatectomy in elderly patients, and influence on their short-term autonomy. Patients and methods: This is a retrospective study conducted between 2002 and 2017 comparing patients less than 65 years old (controls) to those more than 65 years old (cases) from a prospective database, with retrospective collection of geriatric data. Cases were divided into three sub-groups (65-70 years, 70-80 years and > 80 years). Results: Four hundred and eighty-two patients were included. There was no age difference in number of major hepatectomies (P=0.5506), length of stay (P=0.3215), mortality at 90 days (P=0.3915), and surgical complications (P=0.1467). There were more Grade 1 Clavien medical complications among the patients aged over 65 years (P=0.1737). There was no difference in overall survival (P= 0.460) or disease-free survival (P= 0.108) according to age after adjustment for type of disease and hepatectomy. One-third of patients had geriatric complications. The "home discharge" rate decreased significantly with age from 92% to 68% (P=0.0001). Early toss of autonomy after hospitalization increased with age, 16% between 65 and 70 years, 23% between 70 and 80 years and 36% after 80 years (P= 0.10). We identified four independent predictors of loss of autonomy: age > 70 years, cholangiocarcinoma, length of stay > 10 days, and metachronous colorectal cancer. Conclusions: Elderly patients had the same management as young patients, with no difference in surgery or survival, but with an increase in early toss of autonomy. (C) 2020 Published by Elsevier Masson SAS.